title: Comparative effectiveness of a fixed-dose combination of losartan + HCTZ versus bisoprolol + HCTZ in patients with moderate-to-severe hypertension: results of the 6-month ELIZA trial.
abstract: BACKGROUND
  The aim of this study was to compare the antihypertensive efficacy of losartan 100 mg + hydrochlorothiazide (HCTZ) 25 mg versus bisoprolol 10 mg + HCTZ 25 mg and their influence on arterial stiffness and central blood pressure (BP).
  
  
  METHODS
  Of 60 patients with a mean BP of 173.3 ± 1.7/98.4 ± 1.2 mmHg, 59 were randomized to losartan + HCTZ (n = 32) or bisoprolol + HCTZ (n = 27). Amlodipine was added if target BP was not achieved at 1 month, and doxazosin was added if target BP was not achieved after 3 months. Body mass index, office and 24-hour ambulatory BP, pulse wave velocity (carotid-femoral [PWVE] and radial [PWVM]), noninvasive central systolic BP, augmentation index (AIx), laboratory investigations, and electrocardiography were done at baseline and after 6 months of treatment.
  
  
  RESULTS
  Losartan + HCTZ was as effective as bisoprolol + HCTZ, with target office BP achieved in 96.9% and 92.6% of patients and target 24-hour BP in 75% and 66.7% of patients, respectively, after 6 months. Effective treatment of BP led to significant lowering of central systolic BP, but this was decreased to a significantly (P < 0.05) greater extent by losartan + HCTZ (-23.0 ± 2.3 mmHg) than by bisoprolol + HCTZ (-15.4 ± 2.9 mmHg) despite equal lowering of brachial BP. Factors correlated with central systolic BP and its lowering differed between the treatment groups. Losartan + HCTZ did not alter arterial stiffness patterns significantly, but bisoprolol + HCTZ significantly increased AIx. We noted differences in ΔPWVE, ΔPWVM, and ΔAIx between the groups in favor of losartan + HCTZ. Decreased heart rate was associated with higher central systolic BP and AIx in the bisoprolol + HCTZ group, but was not associated with increased AIx in the losartan + HCTZ group.
  
  
  CONCLUSIONS
  Although both treatments decreased both office and 24-hour BP, losartan + HCTZ significantly decreased central systolic BP and had a more positive influence on pulse wave velocity, with a less negative effect of decreased heart rate on AIx and central systolic BP.
authors.affiliation: Secondary Hypertension Department, National Scientific Center, Strazhesko Institute of Cardiology, Kiev, Ukraine.
authors.forename: G D
authors.initials: GD
authors.lastname: Radchenko
authors.forename: Y M
authors.initials: YM
authors.lastname: Sirenko
authors.forename: S M
authors.initials: SM
authors.lastname: Kushnir
authors.forename: O O
authors.initials: OO
authors.lastname: Torbas
authors.forename: A S
authors.initials: AS
authors.lastname: Dobrokhod
mesh_terms: D058671:Adrenergic beta-1 Receptor Antagonists / Q000008:administration & dosage*; D017311:Amlodipine / Q000008:administration & dosage; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage*; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D017298:Bisoprolol / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects*; D018660:Blood Pressure Monitoring, Ambulatory; D002121:Calcium Channel Blockers / Q000008:administration & dosage; D016009:Chi-Square Distribution; D004232:Diuretics / Q000008:administration & dosage*; D017292:Doxazosin / Q000008:administration & dosage; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage*; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D019808:Losartan / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D063177:Pulse Wave Analysis; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014455:Ukraine; D059289:Vascular Stiffness / Q000187:drug effects
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics; D004338:Drug Combinations; C086062:bisoprolol, hydrochlorothiazide drug combination; C505809:hydrochlorothiazide, losartan drug combination; D006852:Hydrochlorothiazide; D017311:Amlodipine; D019808:Losartan; D017292:Doxazosin; D017298:Bisoprolol
keywords: arterial hypertension; arterial stiffness; central blood pressure; combination therapy